Provider Demographics
NPI:1821287566
Name:SIOUX EMPIRE CHRISTIAN COUNSELING INC.
Entity Type:Organization
Organization Name:SIOUX EMPIRE CHRISTIAN COUNSELING INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TONY
Authorized Official - Middle Name:
Authorized Official - Last Name:BOER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-271-0261
Mailing Address - Street 1:2000 S SYCAMORE AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57110-4263
Mailing Address - Country:US
Mailing Address - Phone:605-271-0261
Mailing Address - Fax:605-271-0263
Practice Address - Street 1:2000 S SYCAMORE AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57110-4263
Practice Address - Country:US
Practice Address - Phone:605-271-0261
Practice Address - Fax:605-271-0263
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-18
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD100627Medicare PIN